From disobedience to struggle for adaptation: ​​nursing students' experiences of attending the clinical learning environment during Covid-19 pandemic.

BACKGROUND: The Covid-19 pandemic has affected the clinical education of nursing students all over the world. Considering the importance of clinical education and clinical learning environment (CLE) in the education of nursing students, identifying the challenges and problems faced by these students during the covid-19 pandemic helps to plan more effectively in this regard. The aim of this study was to investigate the experiences of nursing students in CLEs during the Covid-19 pandemic. METHODS: A descriptive qualitative research was conducted, which used a purposive sampling technique to recruit 15 undergraduate nursing students from Shiraz University of Medical Sciences between July 2021 and September 2022. Data were collected through in-depth semi-structured interviews. For data analysis, conventional qualitative content analysis based on Graneheim and Lundman approach was used. RESULTS: The data analysis led to emergence of two themes of "disobedience " and "struggle for adaptation". The disobedience theme consists of two categories: "objection to attend CLE" and "patient marginalization". The theme of struggle for adaptation includes two categories: "using support sources" and "applying problem-oriented strategies". CONCLUSION: At the beginning of the pandemic, the students were unfamiliar due to the disease, as well as fear of contracting themselves and infecting others, so they tried not to be in the clinical environment. However, they gradually tried to adapt to the existing conditions by applying support resources and using problem-oriented strategies. Policymakers and educational planners can use the results of this study to plan for solving the challenges of students during future pandemics and improve the condition of CLE.

Moral distress in psychiatric nurses in Covid-19 crisis.

BACKGROUND: The COVID-19 pandemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient's lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in Iranian psychiatric nurses during the COVID-19 pandemic. METHOD: This qualitative study with a conventional content analysis approach involved 12 nurses at the Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by semi-structured interviews, data analysis was performed based on the five steps of Graneheim and Lundman. RESULTS: By continuous comparison and integration of data, 17 subcategories, 8 subcategories, and 3 categories were extracted from 252 initial codes. The causes of moral distress in psychiatric nurses during the COVID-19 pandemic were identified as emotional responses (Fear and Doubt), relational factors (Nurses' Relationship with Each Other, Nurse-physician Relationship, and Relationship whit Patients), and Institutional factors (Lack of Attention to Health Instructions, Failure to complete the treatment process for patients and Institutional Policies). CONCLUSION: New dimensions of the causes of moral distress associated with the COVID- 19 pandemic are discovered in this study. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.

Challenges of Mental Health in Medical Staffs during COVID -19 Outbreak: A Systematic Review Desafíos de la salud mental en el personal médico durante el brote de COVID-19: una revisión sistemática

Background: The frontline medical staff are under heavy workload conditions and are at high risk of infection with coronavirus disease 2019. This pandemic has burdened unprecedented psychological stress. The study aimed to compile and analyze the challenges of mental health among medical staff during the COVID-19 outbreak Method: PubMed, Scopus, Web of science, and google scholar databases were systematically searched for published studies. Cross-sectional studies examining the impact of the COVID-19 outbreak on the medical staff's mental health were selected. Result: Eventually, 7 articles were extracted for the final analysis after reviewing the titles, s, and full text. The results show that the most common psychological problems of medical staff include stress, anxiety, and depression. The medical staff had higher levels of fear, anxiety, and stress than the management staff. Among physicians and nurses, the two groups that are most involved with patients with COVID-19, the nurses showed more anxiety and stress than physicians. Conclusion: The mental health of the medical staff during the COVID-19 epidemic is at greater risk than ever before. Therefore, it is necessary to adopt comprehensive and effective supportive policies and strategies for health systems and governments.

Challenges of Mental Health in Medical Staffs during COVID -19 Outbreak: A Systematic Review

Background: The frontline medical staff are under heavy workload conditions and are at high risk of infection with coronavirus disease 2019. This pandemic has burdened unprecedented psychological stress. The study aimed to compile and analyze the challenges of mental health among medical staff during the COVID-19 outbreak Method: PubMed, Scopus, Web of science, and google scholar databases were systematically searched for published studies. Cross-sectional studies examining the impact of the COVID-19 outbreak on the medical staff's mental health were selected. Result: Eventually, 7 articles were extracted for the final analysis after reviewing the titles, s, and full text. The results show that the most common psychological problems of medical staff include stress, anxiety, and depression. The medical staff had higher levels of fear, anxiety, and stress than the management staff. Among physicians and nurses, the two groups that are most involved with patients with COVID-19, the nurses showed more anxiety and stress than physicians. Conclusion: The mental health of the medical staff during the COVID-19 epidemic is at greater risk than ever before. Therefore, it is necessary to adopt comprehensive and effective supportive policies and strategies for health systems and governments. Resumen Antecedentes: el personal médico de primera línea se encuentra en condiciones de gran carga de trabajo y tiene un alto riesgo de infección por la enfermedad del coronavirus 2019. Esta pandemia ha causado un estrés psicológico sin precedentes. El objetivo del estudio fue recopilar y analizar los desafíos de la salud mental en el personal médico durante el brote de COVID-19. Método: se realizaron búsquedas sistemáticas de estudios publicados en las bases de datos PubMed, Scopus, Web of Science y Google Scholar. Se seleccionaron estudios transversales que examinaran el impacto del brote de COVID-19 en la salud mental del personal médico. Resultado: Finalmente, se extrajeron 7 artículos para el análisis final después de revisar los títulos, resúmenes y texto completo. Los resultados muestran que los problemas psicológicos más comunes del personal médico incluyen estrés, ansiedad y depresión. El personal médico tenía niveles más altos de miedo, ansiedad y estrés que el personal administrativo. Entre los médicos y enfermeros, los dos grupos que más se involucran con los pacientes con COVID 19, los enfermeros mostraron más ansiedad y estrés que los médicos. Conclusión: La salud mental del personal médico en la epidemia de COVID 19 está en mayor riesgo que nunca. Por lo tanto, es necesario adoptar políticas y estrategias de apoyo integrales y efectivas por parte de los sistemas de salud y los gobiernos.

The effects of continuous care model using a smartphone application on adherence to treatment and self-efficacy among patients with multiple sclerosis.

BACKGROUND: Adherence to disease-modifying therapy is important in patients with Multiple Sclerosis (MS) to increase the positive outcomes and improve the quality of life. This study aimed to determine the effects of Continuous Care Model (CCM) using a smartphone application on adherence to treatment and self-efficacy among MS patients. METHODS: This quasi-experimental study with pre/posttest design was conducted on 72 MS patients in Shiraz, Iran from June 2020 to August 2021. The samples were randomly assigned to intervention (n = 36) and control (n = 36) groups. In the intervention group, the CCM using a smartphone application was implemented during two months. However, no intervention was performed for the control group. The data were collected using the self-report Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ) and MS Self-Efficacy Scale (MSSS) at baseline and two and four months after the intervention. RESULTS: The results showed an improvement in adherence to treatment and self-efficacy in the intervention group compared to the control group after implementing the virtual CCM and at the two-month follow-up (p < 0.001). CONCLUSIONS: Implementing the CCM using a smartphone application resulted in improvements in the MS patients' adherence to treatment and self-efficacy. It can be concluded that providing care using an interactive multimedia application can improve the outcomes as well as patients' satisfaction, especially during the COVID-19 pandemic. Therefore, this approach is recommended to be used for nurses, healthcare providers, and clinicians.

Experience of adherence to treatment among patients with coronary artery disease during the COVID-19 pandemic: A qualitative study.

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused patients with chronic diseases to face various challenges. The present qualitative study aimed to explore adherence to treatment in patients with coronary artery disease (CAD) during the COVID-19 pandemic. Methods: This qualitative content analysis was conducted from September 2020 to February 2021. Online in-depth interviews were conducted with 15 patients with CAD after discharge from Nemazi and Al-Zahra heart hospitals, Shiraz, Iran. Data management was done via MAXQDA 12 software using conventional content analysis based on the method proposed by Graneheim and Lundman. Results: The results revealed three main categories, nine subcategories, and 431 primary codes. The first category was 'improved self-care in the shadow of COVID-19' (Improving self-care due to fear of COVID-19, 'utilization of alternative strategies, and reinforcement of self-care beliefs). The second category was 'redefinition of support systems' (need for a support system, seeking for alternative support systems, and changes in social interactions). The last category was 'barriers to treatment adherence' (shortage of financial resources, need to adjust with working conditions, and mental conflicts). Conclusion: The results indicated that the COVID-19 threats encouraged the patients with CAD to adhere to their care principles. Nonetheless, the restrictions resulting from the pandemic caused problems in adherence to treatment. Thus, redefinition of the support systems in accordance with the present conditions are recommended.